摘要
目的利用前瞻性对照研究对比椎体强化术及经椎弓根穿刺活检两种技术对患者凝血功能的影响,从而探讨经皮椎体强化术时注入骨水泥(聚甲基丙烯酸甲酯,polymethylmethacrylate,PMMA)对凝血功能的影响。方法自2009年10月至2010年9月纳入术前凝血功能无障碍的患者共58例,其中行椎体强化术45例(A组)、经椎弓根穿刺活检13例(B组),所有患者均在穿刺后测定凝血功能及纤溶组合,其中两组在注入骨水泥前后的不同时间点分别测定各项凝血相关指标,以分析手术操作及骨水泥注入对患者凝血功能的动态影响规律。结果 A组在注入骨水泥后D-Dimer均值高于参考值,并且逐渐升高,除在注入骨水泥1 h后和3 h后测量值之间无显著差异以外(P>0.05),其余各时间点相互对比均有显著差异(P<0.01);B组术后D-Dimer均值无显著升高(P>0.05)。所有患者术后其余指标均未超出参考范围。结论经椎弓根穿刺活检术对患者凝血功能未见显著影响,但骨质疏松性椎体压缩骨折患者在行经皮椎体强化术注入骨水泥时会出现D-Dimer值升高,骨水泥可能对患者凝血功能产生影响。
Objective To investigate the effect of the injection of bone cement （polymethylmethacrylate, PMMA） during percutaneous vertebral augmentation on coagulation function by comparing the effects of percutaneous vertebral augmentation and percutaneous transpedicle vertebral bone biopsy on coagulation functions prospectively. Methods A total of 58 patients with normal coagulation function before operation from October 2009 to September 2010 were enrolled. Forty-five patients with osteoporosis vertebral compression fractures （OVCF） in Group A （n = 45） received percutaneous vertebral augmentation. Thirteen patients in Group B （n = 13） received percutaneous transpedicle vertebral bone biopsy. The coagulation function and fibrinolysis function were tested after the puncture in all patients. The coagulation related factors were tested at different time points before and after the injection of bone cement, in order to analyze the dynamic effect of operation and bone cement injection on coagulation function. Results The value of D- Dimer in Group A was higher than reference value, and it increased gradually. Significant difference was observed on all time points （ P 〈 0. 01 ） , except on 1 hour and 3 hours after the injection of bone cement （ P 〉 0.05）. The value of D-Dimer in Group B did not increase significantly after the operation （P 〉 0.05）. Other factors related to coagulation function were normal after the operation in both groups （P 〉 0.05 ）. Conclusion No significant effect of percutaneous transpedicle vertebral bone biopsy on coagulation function is observed. The value of D-Dimer has increased in patients with OVCF who received injection of bonecement during percutaneous vertebral augmentation. Bone cement may have an effect on patients＇ coagulation function.
出处
《中国骨质疏松杂志》
CAS
CSCD
北大核心
2013年第2期154-157,共4页
Chinese Journal of Osteoporosis
基金
广东省中医药管理局资助课题(20111185)
卫生部医药卫生科技发展中心资助课题(W2012ZT07)
